According to the common World Health Organization¹, European Commission² and John Mitchell³ definitions, eHealth refers to the combined use of electronic information and communications technology (ICT) in the health sector to share, store and retrieve electronic health data for prevention, diagnosis, treatment, monitoring, educational and administrative purposes, both on site or at a distance.

Both telehealth and TM (which is a part of it) come under the wider umbrella of eHealth. TM and telehealth take place at a distance, and while TM refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and medical education, in addition to clinical services. Put another way, telehealth delivers healthcare at a distance, including health education, and remote treatment and TM.

Telecare consists of the use of ICT, such as alerts and sensing technologies, for the remote monitoring of care needs, emergencies and lifestyle changes of elderly or vulnerable individuals with physical or mental disabilities for the provision of personalised care services at a distance, supporting patients’ self-management and helping them to remain independent in their home environment.

Sometimes telecare is distinguished from TM and telehealth but often TM and telecare are considered synonymous – they have many similarities but each refers to a different way of using ICT to deliver healthcare services. mHealth can be used in any of these systems and refers to services supported by mobile devices.

From the Greek meaning ‘healing at a distance’, telemedicine (TM) has existed as a term since the 1970s, though it has been around in some form for millennia. We could say that the first use of TM was when ancient civilisations sent smoke signals to warn other clans of a contagious illness outbreak. Today, the idea of TM is to improve patients’ outcomes by increasing access to care and medical information using ICT. Many of us use fitness apps installed on our smartwatches and wristbands which monitor heart rate or pulse in real time. Mobile phones routinely include their own TM apps tracking users’ daily step counts. The fact that these devices – along with laptops and tablets – are in such widespread use means that patient accessibility to remote TM medical services is easier today than it’s ever been. Furthermore, the COVID-19 pandemic has forced an even faster and more broad use of TM around the world. Yet, despite more than 100 peer-reviewed suggestions, we still do not have a standardised definition.

TM was initially introduced to improve health outcomes by overcoming geographical barriers to provide medical services to people living in remote areas using various types of ICT. Today, TM has become an everyday necessity providing clinical support – for people living in both developed and developing regions. When using TM in a specific discipline the name is often shortened to, for example, teleradiology, teledermatology, telepathology or telepsychology.

There are a number of different telehealth service delivery models, including:

The store-and-forward technique (also known as asynchronous TM) – in which pre-recorded healthcare data is exchanged between two or more individuals at different times, so that their presence at the same time is not required. This is usually done through e-mail, so is inexpensive and easy to set up.

Real-time (or synchronous) TM – which requires the immediate transmission of information through a communication device to allow real-time interaction between patient/healthcare professional and other healthcare providers/specialists, who are simultaneously present, but remotely. Usually it is done through video-conferencing equipment, but a phone call or an online chat forum are also interactive forms of synchronous communication.

Remote Patient Monitoring (RPM) – which involves the reporting, collection, transmission and evaluation of patient health data through electronic devices such as wearables, mobile devices, smartphone apps, and internet-enabled computers. RPM technologies remind patients to weigh themselves, check vital signs like blood pressure, oxygen levels and transmit the measurements to their physicians.

A number of mHealth applications  are on the market and available ready to be downloaded and installed on phones which let users get in touch with a medical advisor any time and anywhere.

There are also a number of different examples of medical services provided at a distance:

Teleconsultation – which allows easy and convenient access to medical services and assumes a critical relevance for those who live in rural and remote areas (where sometimes there is a lack of healthcare professionals) and for people with physical disabilities (who can experience difficulties with attending physical consultations). Teleconsultations can help save patients’ time and transportation costs.

Teletriage – which refers to the process of identifying a patient’s problem, accessing the level of urgency and offering advice via phone (by trained professionals), in order to guarantee a safe, timely and appropriate assessment of patient symptoms. The main task of these professionals is the ability to identify urgent symptoms, rather than diagnose symptoms, and make safe decisions regarding patients, recommending on-site or home treatment. Teletriage is beneficial to patients as a powerful tool to use under conditions of urgency or uncertainty. From the health institutions’ perspective, teletriage contributes to reduce healthcare system costs with inappropriate emergency visits.

Telediagnosis – which is the determination of the nature of a patient’s illness, at a remote location, based on clinical data and information (i.e. data, images, and video records) transmitted through ICT.

Telesurgery – which refers to the use of TM equipment and ICT to support and monitor surgical procedures at a distance, or even to perform surgery remotely, such as by telementoring (which consists of remote interactive assistance given by a specialist to a surgeon during a surgical procedure through the use of video and audio connection) or by telepresence/teleintervention surgery (which uses robotised and computerised technologies to actively perform remote surgeries by linking a surgeon’s movements to a scaled-down and very precise movement produced by a small robot machine).

The remote delivery of health care services by using ICT for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, for research and evaluation, and for the continuing education of health care providers all in the interests of advancing the health of individuals and their communities is today a reality for many of us. The number of available TM tools as well as our access to them is increasing constantly, with digital possibilities and applications being so wide-ranging that many solutions we had only recently dreamed about are now both available and essential.